USICH Blog

My passion to address and end homelessness began at the CCNV Federal Shelter in Washington DC in the late 1980’s. The ongoing lack of housing for so many Americans continues to drive my work. Then as now, a place to call home and a job are the most frequently expressed hopes and needs of people experiencing homelessness.

Today we are at a critical juncture. We have a Federal Administration fully engaged in creating and supporting the public-private partnerships necessary to end homelessness in this country. Opening Doors presents the framework for communities to end homelessness. A key part of this effort is ensuring that homeless assistance providers know how to support people experiencing homelessness to obtain employment and training.

We were all given an important opportunity last week to deepen our conversations and strengthen our efforts to end family homelessness when our partners at the U.S. Department of Housing and Urban Development released findings from the Family Options Study. The study compares the outcomes of families experiencing homelessness assigned to three different interventions with the outcomes for families who were assigned to “usual care,” defined as any housing or services that a family accesses in the absence of immediate referral to the other interventions.

To accompany the release of Opening Doors, as amended in 2015, we’re taking a closer look at each of the four key updates to the document.

Spotlight on Uses of Data in Decision-Making and Performance Management

“Before Opening Doors, communities were targeting their resources inconsistently, and many weren’t sure how to do it at all. The Plan has provided a concrete framework that has helped communities match the right resources to the right populations. It has also spurred communities to adopt better ways of measuring their work. We’ve seen over a hundred communities begin to track their housing placements against monthly goals to ensure they are on track to meet the Opening Doors deadlines, a behavior we know correlates with improved local housing performance.” - Beth Sandor, Director of Zero: 2016 for Community Solutions

Data helps us to end homelessness. It allows us to understand the needs of people experiencing homelessness in our communities, put resources in the right place, and measure the results of our efforts.

That's why data takes on even more importance in the newly amended Opening Doors. We have added new strategies related to the use of data in two ways:

Improving data collection and integration at the Federal level to increase our understanding of the full scope of and trend on homelessness

Supporting the use of data at the community-level to improve the delivery of housing and services to people experiencing homelessness

To accompany the release of Opening Doors, as amended in 2015, we will be taking a closer look at each of the four key updates to the document this week. We’ll be sharing comments from partners, community members, and the USICH staff on how the updates are impacting their daily work, helping to prevent and end homelessness across America, as well as highlight the key changes around the updated topic.

Spotlight on Changing of the Goal of Ending Chronic Homelessness

“The national goal and deadline for ending chronic homelessness set by Opening Doors enabled states like Utah to generate the momentum and energy needed to achieve our goal. And if Utah can do it, anyone can do it. Moving the target date for ending chronic homelessness in 2017 still gives states, counties, and cities the hard deadline they need to cultivate champions and re-purpose existing resources, while securing additional resources needed to achieve the goal.

Among people experiencing homelessness, there is a subset of individuals who experience homelessness for long periods of time, and/or in repeated episodes over many years—people experiencing chronic homelessness. These men and women commonly have a combination of challenges including mental health problems, substance use disorders, and complex health conditions that worsen over time and often lead to an early death. Studies have found that people experiencing chronic homelessness cost the public between $30,000 and $50,000 per person per year through their repeated use of emergency rooms, hospitals, jails, psychiatric centers, detox and other crisis services, the use of which make little improvements to their health and well-being. Given the cost it bears in human lives and public dollars, ending chronic homelessness is a moral and fiscal imperative.

The solution to end chronic homelessness is permanent supportive housing, which combines affordable housing with tailored, supportive services. This combination of housing and support helps people achieve housing stability, connections to care, and improved health and social outcomes.

To accompany the release of Opening Doors, as amended in 2015, we will be taking a closer look at each of the four key updates to the document this week. We’ll be sharing comments from partners, community members, and the USICH staff on how the updates are impacting their daily work, helping to prevent and end homelessness across America, as well as highlight the key changes around the updated topic.

Spotlight on Medicaid

"When launched in 2010, Opening Doors was more than a blueprint for effective Federal, state and local partnerships to end homelessness, it motivated all of us - inside and outside of government - to work harder, together, to address the needs of our most vulnerable people. Five years later, it is just as impactful; a platform on which proven solutions such as supportive housing can expand, and an affirmation that services through Medicaid, coordinated assessment and access, and cooperation among systems must grow too if we are to succeed and tackle homelessness once and for all." –Deb DeSantis, President/CEO, Corporation for Supportive Housing

The Affordable Care Act creates new opportunities to leverage Medicaid to end homelessness, specifically by financing services that can help people obtain and maintain housing as well as achieve health and well-being. All states now have the opportunity to expand Medicaid eligibility to nearly all individuals under the age of 65 with incomes up to 133 percent of the Federal poverty level. As of May 2015, 30 states including the District of Columbia have acted to expand Medicaid programs, and provide health coverage to millions of adults without dependent children for the first time. More than 16 million Americans have gained health coverage, bringing the number of people without insurance down to historic lows. Included in the newly insured are approximately six million of the lowest income Americans, who have gained access to public health insurance through Medicaid and the Children’s Health Insurance Program (CHIP). And while the data is limited on the specific number of people experiencing homelessness who have gained coverage, we have numerous reports that enrollment in Medicaid and other types of health insurance among people experiencing homelessness has grown significantly.

To accompany the release of Opening Doors, as amended in 2015, we will be taking a closer look at each of the four key updates to the document this week. We’ll be sharing comments from partners, community members, and the USICH staff on how the updates are impacting their daily work, helping to prevent and end homelessness across America, as well as highlight the key changes around the updated topic.

Spotlight on Crisis Response Systems

“Over the last few years, we’ve learned a great deal about how to transform the way we respond to homelessness, moving from a set of uncoordinated programs towards systems that help families and individuals rapidly reconnect to permanent housing. This updated version of Opening Doors captures those lessons and outlines the critical steps communities can take to retool homeless services into effective crisis response systems.”

– Nan Roman, Executive Director, National Alliance to End Homelessness

Since the launch of Opening Doors five years ago, communities across the country are transforming their responses to homelessness from what was once a set of uncoordinated programs and services to crisis response systems that help people rapidly resolve their homelessness through connections to stable housing. In order to further guide communities through this transition, the 2015 amendment to Opening Doors includes clearer guidance around how to retool homeless services into a coordinated crisis response system.

This crisis response system involves the re-orientation of programs and services to a Housing First approach that emphasizes rapid connection to permanent housing, while mitigating the negative and traumatic effects of homelessness. An effective crisis response system:

On behalf of the entire team at USICH, the teams at our Federal member agencies, and our many dedicated state and local partners working tirelessly to prevent and end homelessness, I am thrilled to share with you this updated version of Opening Doors, as amended in 2015.

This document is the culmination of a tremendous amount of work by countless individuals who contributed ideas and information through online forums, in meetings, and by analyzing their agencies’ programs and policies, helping to identify best practices and lessons learned from their years of experience. That collective wisdom has shaped and strengthened this amendment and its focus on objectives and strategies informed by data, research, and results.

The release of this amendment could not be more timely. We have made great strides toward the goals established in Opening Doors, but there remains a large amount of work to be done. Today, on the anniversary of the original publication, we reaffirm our commitment to achieving an end to homelessness in America, with even greater confidence in our collective ability to solve this problem.

Together, we are proving that homelessness does not have to appear in the pages of American history as a permanent fixture, but as a problem the American people overcame. It is my hope that the release of this amendment to Opening Doors will help move us closer to the lasting solutions that we can and must implement.

Pima County and the City of Tucson hosted three Cabinet Secretaries and the Executive Director of the U.S. Interagency Council on Homelessness last week at Pima County’s Sullivan Jackson Employment Center, showcasing our collaboration to end Veteran homelessness and help people experiencing homelessness reenter the workforce.

Local elected officials accompanied Housing and Urban Development Secretary Julian Castro, Labor Secretary Thomas Perez, Veterans Affairs Secretary Robert McDonald, and USICH Executive Director Matthew Doherty on a tour of Pima County’s Sullivan Jackson Employment Center – one of three stops they were making in western states during the All In City Swing. The purpose of the visit was to learn more about the Center’s impressive record of helping people experiencing homelessness, including military veterans, return to meaningful employment. The county-funded agency also receives Federal and City of Tucson funds for its ongoing operations.

The group met with several current and former Sullivan Jackson clients to hear how the Center has helped them with job training, housing assistance, and educational opportunities to get them back on track to success and stability. Such paths are often not smooth and the clients also discussed with the Secretaries and officials the problems they experienced navigating through various programs.

This blog was originally published on the Bill and Melinda Gates Foundation blog, Impatient Optimists.

By David Wertheimer

Twenty-five years ago, in the earlier years of the AIDS epidemic, health care and housing providers figured out that without housing, the health of people living with AIDS deteriorated far more rapidly than for those who had stable homes. AIDS Housing of Washington, now Building Changes, helped coin a critically important phrase that became a game changer in the fight against AIDS: “Housing is healthcare.”

A quarter century later the phrase still rings true, and has expanded meaning in the challenging work of ending homelessness for all people, including families, single adults, youth, and veterans.

The Bill & Melinda Gates Foundation recently hosted more than 100 state and local leaders in ending family homelessness together with health care leaders responsible for implementing the Affordable Care Act (ACA) and Medicaid expansion here in Washington State. As the health care system changes, the opportunities to integrate and improve the delivery of both housing and health services to families recovering from homelessness have the potential to be transformational.

What might this look like in practice? We can now envision and realize the possibilities, thanks to a 5-year, $65 million competitive federal grant for State Innovations in Medicaid secured by the Washington State Health Care Authority. In part, this grant offers the opportunity to think in new and innovative ways about “social determinants of health,” the broad set of conditions in which we live and work, at home and with our families, including the air we breathe and the water we drink, that play a more important role in promoting long-term health than medical interventions.